Other Reasons For Hirsutism With Normal TestosteroneWomen’s levels of testosterone are at their highest in the late teens and early 20s. After that levels decline until after menopause when they are usually very low. But here’s the unfair part: once stimulated by testosterone, hair follicles stay over-active. A woman might have slightly high testosterone levels when she is in her 20s, but by the time she has a workup some years later, the elevations are already long gone. However the follicles haven’t forgotten and keep on producing thick, dark hairs.

Another cause of misleading test results is that testosterone is released into the blood episodically. Levels fluctuate and so testosterone may be high only sometimes. But hair follicles are stimulated every time the testosterone level goes up. A single blood draw may miss the peaks.

A sudden or large increase in hair makes it important to see if hormone levels are high. If they are, a hormonal disorder is present and more work-up may be needed. If levels are normal, there is usually no hormonal disorder, just a problem with sensitive follicles.

Increased hair can be treated whether testosterone levels are normal or elevated. Medications which block androgens such as spironolactone (Aldactone®) work in both situations because they protect the hair follicles against the testosterone.

If you have increased hair but normal hormones, don’t believe it if you are told that nothing can be done. There are several treatments which can greatly reduce the amount of hair. If your testosterone is high, or there are other abnormal hormone levels, treatment can significantly reduce hair but more medications may be needed in order to help with other effects of the hormonal abnormality.

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